New India Assurance Claim Form

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New India Assurance claim form for group medical insurance

The New India Assurance claim form for your New India Assurance group health insurance has two parts namely, claim form part A, and claim form part B. Part A form is filled out by the policyholder or the insured and part B is filled out by the hospital where the treatment was taken. This will be a non-network hospital of the New India Assurance health insurance company.

Download the New India Assurance Claim form

How to fill New India Assurance claim form for your group medical insurance policy?

1. Inform the New India Assurance health insurance company or the TPA associated with them about the hospitalisation. The New India Assurance claim form can be downloaded from the Pazcare dashboard.
2. Fill in your New India Assurance group medical insurance policy number followed by the claim number and the company/ TPA Id number. These details will be present on your New India Assurance group medical insurance Id card.
3. Fill in your personal details of the primary insured in first section. These include the personal details of the primary insured.
4. Please mention the details of the insurance policy (if you are covered by any other health insurance policy) under section B in your New India Assurance health insurance claim form.
5. Under section - C fill in the personal details of the insured person hospitalised.
6. Fill in the details of the hospitalisation under section D of your New India Assurance insurance claim form. This includes the name of the hospital, the type of room occupied, the reason for hospitalisation, date of hospitalisation, date of injury etc.
7. Under section E fill in the details of the claim. This includes pre and post-hospitalisation expenses, ambulance charges, etc. Also mention details of the hospitalization like if it's a domiciliary hospitalisation. Also, mention all the benefits applicable to your group mediclaim policy according to the terms and conditions of the policy.
8. Ensure to enclose the other required documents mentioned in your New India Assurance reimbursement claim form checklist. Mention its details under section F of the reimbursement claim form.
9. Fill in the bank account details of the primary insured under section F of the claim form. Also, enclose a cancelled cheque leaf for the New India Assurance reimbursement claim for your group medical cover. Sign the declaration mentioned at the end of the claim form.
10. The New India Assurance claim form part B will be duly filled by the hospital where the treatment was taken. As mentioned earlier, the reimbursement claim is raised when the insured is admitted to a non-network hospital.

New India Assurance claim form filled sample

New India Assurance reimbursement claim process for your group health insurance policy

After you fill out the New India Assurance claim form, here is how you will file for the reimbursement claim.

1. A reimbursement claim can be filed when the insured is admitted to a hospital not associated with New India Assurance health insurance company.
2. Make sure you collect all the necessary documents to file the New India Assurance reimbursement claim. This also includes all the original copies of hospital bills and a duly filled New India Assurance claim form.
3. Also, make sure you have xerox copies of all the attached documents for your reference.
4. You can submit these documents online/offline based on your convenience.
5. The New India Assurance claim status can be reviewed on the New India Assurance insurance website.

Download the New India Assurance Claim form